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Targeted Brain Stimulation Could Benefit Chronic Pain Treatment
Less than 2 minutes of transcranial magnetic stimulation that targeted a precise location in the left dorsolateral prefrontal cortex (DLPFC) of the brain boosted hypnotizability for about an hour in low-to-medium hypnotizable people living with fibromyalgia, according to study results published in Nature Mental Health.
The double-blinded, randomized controlled trial recruited 80 patients with fibromyalgia, a pain disorder that has shown improvement with hypnotherapy. Patients with hypnotic induction profile scores indicating high hypnotizability were excluded from the study.
The research team team emphaized that even a transient increase in hypnotizability could allow more patients to access hypnosis for chronic pain. There is also the possibility that neurostimulation could shift other traits long considered stable or even enhance response to psychotherapy.
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“As a clinical psychologist, my personal vision is that, in the future, patients come in, they go into a quick, noninvasive brain stimulation session, then they go in to see their psychologist,” said lead author Afik Faerman, PhD. “Their benefit from treatment could be much higher.”
Participants were randomly assigned to receive either active or sham continuous theta-burst stimulation over a personalized, neuroimaging-derived left DLPFC target. The research team explained that previous research by study author David Spiegel, MD, identified stronger functional connectivity between the left DLPFC and the dorsal anterior cingulate cortex in people with high hypnotizability. The left DLPFC is involved in information processing and decision-making, while the dorsal anterior cingulate cortex is involved in stimuli detection.
“It made sense that people who naturally coordinate activity between these two regions would be able to concentrate more intently,” Dr Spiegel said. “It’s because you’re coordinating what you are focusing on with the system that distracts you.”
Participants who received active transcranial magnetic stimulation, delivered as two 46-second applications of 800 pulses of electricity each, showed a statistically significant boost in hypnotizability immediately after the intervention, according to the study. The sham group showed no effect.
During retesting an hour later, the increase in hypnotizability in the active group had worn off.
“We were pleasantly surprised that we were able to, with 92 seconds of stimulation, change a stable brain trait that people have been trying to change for 100 years,” said Nolan Williams, MD, a corresponding author and associate professor of psychiatry and behavioral sciences at Stanford University, Palto Alto, California. “We finally cracked the code on how to do it.”
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